The University of Washington School of Medicine serves as the sole medical educational resource for 5 states in the US Northwest: Washington, Wyoming, Alaska, Montana, and Idaho. It is also recognized as a major institution in biomedical research; since 1974, UW ranks first amongst American public universities for federal research funding and second amongst all universities (public and private) since 1991 for competing federal science and engineering grants. Within the UW, the Division of Gastroenterology of the Department of Medicine, composed of a core of 36 full-time faculty members, operates from five medical centers: the University of Washington Health Sciences Center, the Veterans Affairs Puget Sound Health Care System, the Harborview Medical Center, the Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center, and Pacific Medical Clinics. This diversity allows the research and clinical programs of the GI Division to benefit from complementary strengths, ranging from tertiary referral centers to primary care centers in urban or rural setting, and from highly specialized centers to broadly diversified county medical centers. Benefiting from these strengths, the GI Division has had a long tradition of training academic fellows, dating to the 1950's. This application requests two trainees per year who will undergo rigorous research training for two year (4 positions total). SPECIFIC AIMS: Our training program has two specific aims that are integrated through our clinical and translational research infrastructure: . Translational Research in Gastrointestinal and Liver Disease 2. Epidemiology, Outcomes & Health Services Research. We propose multidisciplinary research between our specific aims spanning the definition of translational research. Specifically, the research infrastructure to conduct research using biological samples linked with baseline clinical data and long-term follow-up of clinical outcomes has been constructed in the Division of Gastroenterology as a means to allow every patient to participate in research. This infrastructure will allow us to develop cohorts of patients that are categorized with regards to clinical risk factors and biological parameters and follow them to observe clinical outcomes including disease incidence, morbidity and mortality. It is the availability of these clinically and biologically characterized cohorts with longitudinal follow-up that distinguish our program from others. PUBLIC HEALTH RELEVANCE: This training grant application proposes to integrate basic science with clinical research to develop the next generation of tools that will enhance diagnosis, stratify risk and tailor therapy using state-of-the-art techniques available in bench research coupled with sophisticated methods to study patients as they progress through disease and health. Trainees in our program will be exposed to a wealth of resources and be mentored by highly successful preceptors dedicated to developing the foundation for their future careers in academic medicine.